Abstract
We report an unusual patient with primary adenocarcinoma of lung causing malignant pleural and pericardial effusions. The diagnosis was made only at autopsy as his staging computed tomography scan of chest was negative for an obvious mass lesion within the lung or pleura. Prior to his death, his symptoms were erroneously managed as left ventricular failure and community-acquired pneumonia.
Highlights
On examination, he was afebrile and haemodynamically stable
The initial differential diagnoses included pulmonary embolism or left ventricular failure and the patient was started on subcutaneous therapeutic doses of a lowmolecular weight heparin injection
A computed tomography pulmonary angiogram (CTPA) on the following day showed no evidence of pulmonary embolism, but there was a significant 3.5 cm pericardial effusion and bilateral pleural effusion with right basal consolidation (Figure 1)
Summary
Carcinoma of the lung is the second most common cancer in the UK (having recently been overtaken by breast cancer). The symptoms of dyspnoea, chest pain and cough experienced by the patient, were consistent with other differential diagnoses such as pulmonary embolism, or lower respiratory tract infection On his last hospital admission, raised levels of inflammatory markers and the appearance of consolidation on chest CT scan were more suggestive of an infective process. It is not surprising, that the correct diagnosis of metastatic lung cancer could not be made before this patient's death. Apart from cancerrelated factors increasing blood coagulopathy, a number of other factors including reduced mobility, dehydration, surgery for the cancer, certain chemotherapeutic agents, and the use of indwelling central venous catheters for chemotherapy, potentiate the risk[4]
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